13th International Conference on Health Promoting Hospitals

Transcription

1 13th International Conference on Health Promoting Hospitals (HPH): V:\PROJEKTE\2ic\IC 2005\produkte\final program\program-april 2005 Dublin, Ireland, May 18-20, 2005 Empowering for health practicing the principles Book of abstracts 1

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3 Contents CONTENTS...3 LETTERS OF WELCOME...5 SCOPE AND PURPOSE OF THE CONFERENCE...7 CONFERENCE PARTNERS...9 Organisers... 9 Co-organisers... 9 Scientific Committee... 9 Local Organising Committee... 9 PLENARY ABSTRACTS...11 Plenary I: Thursday, May 19, 2005, The Hospital - A Staff Empowering Work Place. 11 Plenary II: Thursday, May 19, 2005, Empowering hospital patients for managing their health Plenary III: Friday, May 20, 2005, Empowering vulnerable groups of patients Empowering Vulnerable Groups Of Patients Plenary IV: Friday, May 20, 2005, Frameworks for empowering hospitals to become empowering organisations ABSTRACTS FOR PARALLEL PAPER SESSIONS AND CONFERENCE WORKSHOPS...17 Parallel Sessions I: Thursday, May 19, 2005, Session I-1: Culturally competent and Migrant Friendly Hospital Session I-2: Smoke Free Hospitals Session I-3: Health promotion for hospital staff 1: Supportive policies and programs Session I-4: Health promoting service provision for older persons Session I-5: Developing the health promotion quality of hospital services Session I-6: Empowering patients in clinical practice Parallel Sessions II: Thursday, May 19, 2005, Session II-1: Smoke Free Hospitals Session II-2: Health promoting psychiatric health care services Session II-3: Health promotion for patients with chronic diseases COPD Session II-4: Aspects of developing Health Promoting Hospital organisations Session II-5: Further developing the hospital into a health promoting setting Session II-6: Mother, parent and Baby Friendly Hospitals & community health issues Parallel Sessions III: Friday, May 20, 2005, Session III-1: Health promotion for children and adolescents in hospitals Session III-2: Workshop: How can we integrate mental health promotion action in Health Promoting Hospitals? Session III-3: Pain-free Hospitals Session III-4: Empowering patients for healthy lifestyles Session III-5: Empowering patients for chronic diseases cardio-vascular problems, AIDS

4 Session III-6: Culturally competent and Migrant Friendly Hospitals Parallel Sessions IV: Friday, May 20, 2005, Session IV-1: Empowering patients and carers to cope with chronic conditions Session IV-2: Strategies for empowering older persons Session IV-3: Developing health promoting programs and services in HPH organisations Session IV-4: Health Promotion For Hospital Staff 2: Coping with work related risks and developing health promoting lifestyles Session IV-5: Supportive frameworks & networking for HPH Session IV-6: Aspects of developing Health Promoting Hosptial organisations ABSTRACTS FOR CONFERENCE POSTER SESSIONS Poster Sessions I: Thursday, May 19, 2004, Session I-1: Health Promotion In Clinical Practice Session I-2: Mother And Baby Friendly Hospitals For Patients, Staff And Community Session I-3: Health Promotion For Children And Adolescents In Hospitals (I) Session I-4: Chronic Diseases (I): Health Promotion For Patients With Diabetes And Metabolic Disorders Session I-5: Chronic diseases (II): Health promotion for cancer patients Session I-6: Empowering Patients For Healthy Lifestyles Session I-7: Health Promoting Psychiatric Health Care Services & Mental Health Promotion In Hospitals (I) Session I-8: Culturally competent and Migrant Friendly Hospitals Session I-9: Smoke-Free Hospitals (I) Session I-10: Staff Health Issues (I): Tackling Specific Risks Session I-11: Staff Health Issues (II): Staff Surveys & Training For Health Promoting Work Performance Session I-12: Developing Health Promoting Hospital Organisations Poster Sessions II: Friday, May 28, 2004, Session II-1: Health Promotion For Children And Adolescents In Hospitals (II) Session II-2: Chronic Diseases (III): Health Promotion For Patients With Breathing Disorders And For Patients With Cardio-Vascular Problems Session II-3: Chronic Diseases (IV): Health Promotion For Diverse Chronic Conditions Session II-4: Health promotion for older patients Session II-5: Health Promoting Psychiatric Health Care Services & Mental Health Promotion In Hospitals (II) Session II-6: Pain Free Hospitals Session II-7: Health Promoting Integrated Care Session II-8: Smoke-Free Hospitals (II) Session II-9: Staff Health Issues (III): Empowering Staff For Health Promoting Life Styles & Further Developing The Hospital Setting Into A Health Promoting Working Environment Session II-10: Health Promotion As A Quality Issue & Further Developing The Hospital Into A Health Promoting Setting Session II-11: Contributions of HPH to community health health promotion in the community PAST HPH CONFERENCES: INDEX OF AUTHORS

5 Letters of Welcome LETTER OF WELCOME FROM WHO On behalf of WHO, we have the pleasure of welcoming you to the 13th International Conference on Health Promoting Hospitals (HPH). In the last years the Health Promoting Hospitals Network has made major progress in establishing an evidence-base, clarifying principles and developing tools to implement health promotion activities in hospitals. This is also reflected in the title of this year s conference Empowering for Health: Practicing the Principles. During the conference many important issues in empowering patients, staff and vulnerable groups will be discussed: A lot of evidence and models of good practices have become available on the empowerment of patients in clinical interventions. What are the latest experiences in patient education and counseling strategies and how can we place more emphasis in research and implementation on issues such as empowerment of chronic patients to better manage their conditions and develop healthy lifestyles? Hospitals are risky working places and health promotion for staff has been an important focus of HPHs from the beginning. Work-related injuries and occupational stress have been recognized as major issues in many hospitals; however, in order to put into practice the principle of empowerment for staff more attention should be drawn on leadership and teamwork issues. How can we put into practice the experiences from other initiatives in creating better and healthier working places? Empowerment of vulnerable groups like elderly, migrants, ethnic minorities and persons with mental health problems has become an important issue within HPHs and raises many questions on communication processes, language barriers and cultural differences. How can strategies on empowering these vulnerable groups be developed and what are the implications for the working processes in hospitals? As experience has shown in the past, dedication and expertise of individuals are not enough to fully implement health promotion strategies and therefore this conference will finally address financial regulations and quality criteria to support hospitals in putting into practice the principle of empowerment. Can we assess whether empowerment is being practiced in an organization and how can we provide incentives in order to do so? Different plenary and parallel sessions, workshops and poster presentations will provide opportunities for exchanging ideas and know-how, discussing projects and meeting and networking with colleagues from around the world. For the first time, a summer school was organized by the WHO Collaborating Centre for Evidence-Based Health Promotion and we hope that this exciting event will become a regular feature of the conference programme. Organizing the HPH conference is a big team effort; therefore, we would like to thank all persons involved for their cooperation and dedication in making this conference a successful event. We would also like to congratulate both hosts of the conference, the Irish HPH Network and the Northern Ireland Regional HPH Network for this very successful collaboration that will hopefully result in an ongoing exchange to promote and improve health. Looking forward to seeing you in Dublin! Milagros Garcia-Barbero and Oliver Gröne WHO Regional Office for Europe LETTER OF WELCOME BY LOCAL HOST On behalf of the Mayor of Dublin, the Irish Health Promoting Hospitals Network (HPH) and the Northern Ireland Regional HPH Network - organisers of the 13 th International Conference on HPH we take pleasure in welcoming you to the city of Dublin. Since the inception of the HPH movement in 1990, involvement and participation from Ireland, both north and south, has been extremely active. While both networks have developed very differently and have their own distinct support and financial structures, both have sought to develop and promote the HPH concept widely throughout the two jurisdictions. The value of the health service as a setting for the promotion of health is now firmly established, as is the role of the hospital in the promotion of health. It recognizes that health promotion interventions in hospitals need not only to address change in individuals but also the underlying norms, rules and cultures within our organizations. HPH is not simply about doing or having health promotion activities or interventions within our hospitals; it is about affecting decision-making so that organizational changes in both services and structure reflect that empowering for health principles are an integral aspect. The Local Organizing Committee has worked hard to ensure that conditions are in place for an effective and successful conference. We believe that it is a privilege to host this prestigious international health conference in Dublin and believe that the large anticipated international presence at this conference will contribute significantly to the continued development of the HPH movement throughout the island of Ireland. Welcome to Dublin! We hope that you enjoy your stay and we are looking forward to seeing old friends and meeting new ones! Ann O`Riordan and Hazel Brown Irish HPH Network and NI Regional HPH Network 5

6 LETTER OF WELCOME BY WHO-COLLABORATING CENTRE, VIENNA On behalf of the Scientific Committee, we have the pleasure to welcome you at one of the biggest conferences in the history of the WHO-HPH network. More than 520 visitors from 40 countries have been attracted to attend this event by Dublin and by the topics of this conference. This number of colleagues will work together in four plenary sessions with 10 lectures, 24 parallel sessions with 108 oral presentations, and 2 poster sessions with as many as 246 posters. 55 persons will be active in chairing these sessions. We would like to thank everybody who contributed to developing the scientific programme of this conference: The Irish and Northern Ireland Netowrks of HPH, who made it all happen and who are providing a very supportive framework for the conference; The 47 members of the Scientific Committee for their suggestions for developing the conference program, and for screening a total of 403 abstracts; The 9 co-organising organisations of this conference who supported the Scientific Committee and who helped to create visibility and related HPH to a variety of different relevant communities; The 10 plenary speakers and the 354 delegates who will present in parallel paper and poster session; And all participants in this conference. Already now, we would like to inform you that a virtual conference publication of this event is planned. Everybody who has an active contribution is invited to send in either slides and / or a written text about the presentation, latest until June 30, 2005, to: hph.soc-gruwi@univie.ac.at. And we would like to invite you to support the continuous quality development of the International Conferences on HPH by filling in the evaluation form which is provided in your conference package. We are happy that Empowering for health practicing the principles motivated so many colleagues and friends to attend, since it is always a risk for a planning committee to decide on conference topics. We hope that the conference will provide you with many ideas and concrete suggestions and thus enable you to further implement empowerment strategies into your own health promotion work, and maybe even into aspects of your personal life. We wish you a lot of mutual learning, fruitful discussions, and networking! Jürgen M. Pelikan and Christina Dietscher (Chair and contact, Scientific Committee) 6

7 Scope and purpose of the conference Since WHO defined health promotion as the "process of enabling people to increase control over, and to improve their health" (Ottawa Charter 1986), the use of this approach which is also known as "empowerment", has been widely discussed for health enhancing strategies like the development of communities, healthy workplaces and settings, as well as individual lifestyle changes. But how effective, acceptable and applicable are empowerment strategies with their focus on self-responsibility, self-determination and participation in the everyday routines of expert organisations like modern hospitals? According to practical experiences and scientific research, empowering interventions offer many potentials for improving health outcomes of patients, as well as health impact on hospital staff. This especially holds true for vulnerable and often rather "powerless" groups of patients and staff. How then can hospitals implement empowering interventions in their everyday structure and culture, and what would be supportive (financial and quality) frameworks for enabling hospitals to become "empowering organisations" for patients, staff, and citizens? In the last 15 years, a considerable amount of knowledge and experiences around these issues has been developed within the International Network of HPH. These will be presented and discussed at the 13th International Conference on HPH in Dublin, with two Irish Networks of Health Promoting Hospitals as local hosts who have the issue of empowerment high on their agenda. HOW CAN HOSPITALS USE EMPOWERMENT TO IMPROVE PATIENTS' HEALTH? Improving the health of patients is the core business of hospitals. For this purpose, what added value can empowerment strategies provide, in addition to the established medical, nursing and therapeutic interventions? There is already a tradition of investing in additional (educative) services for improving patients' ability to live with (chronic) disease, and for developing healthy lifestyles. But hospitals can also use empowerment to enhance the quality of their core services: Enabling patients - and their relatives, or social network - to actively co-operate in diagnostics, therapy and care, as well as to take responsibility for their basic physical, mental and social health needs during hospital stay, can contribute to reduce complications, drug consumption, and length of stay. Specific issues to be discussed on the basis of models of good practice and research will include: Empowerment in clinical interventions: Strategies include patient education, information, training and counselling for informed consent, shared decision-making, enhancing compliance, co-operation and co-production of health; Strategies for empowering patients to take care of their basic health needs during hospital stay, e.g. by providing orientation about hospital services, day schedules, opportunities for communication, infrastructures; Services for empowering patients to better manage (chronic) diseases: Education, information, training and counselling concerning major chronic conditions (coronary heart disease, stroke, cancer, diabetes mellitus, COPD, ) but also concerning rehabilitative services; Services for empowering patients to develop health promoting life styles: Strategies include education, information, training and counselling concerning smoking, nutrition, exercise and other lifestyle issues. HOW CAN EMPOWERMENT CONTRIBUTE TO IMPROVE THE HOSPITAL'S IMPACT ON STAFF HEALTH? As workplaces, hospitals represent a number of considerable health risks for their staff. In addition to the traditional strategies of health protection, disease and accident prevention at the workplace, research shows a considerable positive effect of participatory, empowering management and teamwork styles, including the participatory organisation of work processes, on staff health. Strategies in line with these findings are also enhanced by the European Network of Workplace Health Promotion and by the European Agency for Safety and Health at Work. Specific issues to be discussed on the basis of models of good practice and research will include: How can hospitals (further) develop supportive leadership competencies and health enhancing teamwork, including conflict management, mutual support, mobbing prevention? What can be done to enable individual staff members for health promoting work performance, e.g. by providing opportunities for continuous professional education and training; by encouraging staff to suggest ideas on the improvement of work organisation; by providing working hours and recreation periods that fit personal needs (with regard to family life, age); by providing decision-making authority for areas of personal job responsibilities, etc? How can staff be empowered and supported to develop health promoting individual strategies for managing health risks or for coping with already existing health problems? HOW CAN HOSPITALS EMPOWER SPECIFIC VULNERABLE GROUPS LIKE ELDERLY, MIGRANTS AND ETHNIC MINORITIES, AND PERSONS WITH MENTAL HEALTH PROBLEMS? All issues of empowerment are especially important for members of socially vulnerable groups. Patients - and staff - from these groups have the greatest needs and offer the largest potential for health improvement by empowerment strategies. Based on recent demographic and epidemiological trends, this conference will have a specific focus on empowering the elderly, migrants and ethnic minority groups, and persons with mental health problems - three groups which will be increasingly represented amongst hospital patients (and staff). As patients who belong to these groups offer a considerable risk for additional irritation, conflicts and stress in the hospital, strategies that allow to better adapt to their needs will also contribute to improve the health impact on hospital staff, as well as the efficiency of hospital services. 7

8 Specific issues to be discussed on the basis of models of good practice and research will include: How can hospitals develop empowering clinical services for vulnerable groups of patients like screening for specific risks and needs already at admission; encouraging patients to communicate expectations concerning professional behaviour; adapting clinical communication to patient expectations, language and hearing problems; adapting existing patient information, training and counselling services and material for vulnerable tar-get groups? What can hospitals do to create supportive settings for vulnerable groups, e.g. by enabling them to communicate their specific needs with regard to food, day schedules, religious services, and by adapting hospital routines and infrastructures to meet these needs? What information and education do staff need to be enabled to meet the needs of vulnerable groups? How can hospitals improve cooperation with other health care and community services in order to support continuous and integrated support of vulnerable patients? HOW CAN FINANCIAL REGULATIONS AND QUALITY CRITERIA BE ADAPTED TO "EMPOWER HOSPITALS FOR EMPOWERMENT"? If hospitals are expected to change their structure and culture towards empowerment, they need supportive frameworks to do so: Financial incentives and quality criteria, as formulated in legal regulations, standards of accrediting bodies, and professional organisations, must make it feasible, reasonable and necessary to develop in this direction. Specific issues to be discussed on the basis of models of good practice and research will include: Financial frameworks to allow hospitals to invest in the empowerment of patients, staff and vulnerable groups: How can health promotion and empowerment strategies be introduced in DRGs, in payment systems which are oriented at performance indicators and targets, in payment by results, in fee for service practice, and in other financial frameworks? Quality criteria: What experiences do exist in Europe with regard to incorporating health promotion and empowerment as quality criteria for hospital core services into national, regional and professional quality systems like EFQM, balanced score card, standards, guidelines, monitoring, accreditation, and reporting? What is the impact of centralising or decentralising strategies (e.g. hospital clusters), and of patient involvement in strategic decision making, on the development of financial frameworks and quality criteria? 8

9 Conference partners Organisers WHO-Regional Office for Europe ( Irish Network of Health Promoting Hospitals ( Northern Ireland Regional Network of Health Promoting Hospitals ( Department of Health and Children, Republic of Ireland ( Health Promotion Agency, Northern Ireland ( Investing for Health, Northern Ireland ( WHO Collaborating Centre for Health Promotion in Hospitals and Health Care ( Co-organisers EC European Commission ( HOPE Standing Committee of the Hospitals of the European Union ( ) PCN Standing Committee of the Nurses of the European Union ( IUHPE International Union for Health Promotion and Education ( IAPO International Alliance of Patients Organizations ( EAHM European Association of Hospital Managers PWG Permanent Working Group of European Junior Doctors ( ENWHP European Network of Workplace Health Promotion ( ENSH European Network of Smoke-Free Hospitals ( Scientific Committee Hartmut BERGER (HPH Task force on Health Promoting Psychiatric Hospitals, Riedstadt), Elimar BRANDT (German National HPH Network, Berlin), Zora BRUCHACOVA (Slovak National HPH Network, Bratislava), Pierre BUTTET (French National HPH Network, Vanves Cedex), Izolda S. CHEREPANOVA (Russian National HPH Network, Moscow), Antonio CHIARENZA (HPH Task Force on Migrant Friendly, Hospitals, Reggio Emlia), Luke CLANCY (Chairman, Irish HPH Network, Dublin), John K. DAVIES (President, International Union for Health Promotion and Education Europe IUHPE, Brighton), Manuel DELGADO (President, European Association of Hospital Managers, Lisbon), Christina DIETSCHER (Austrian National HPH Network, Vienna), Jacques DUMONT (Belgian HPH Network of the French Community, Brussels), Carlo FAVARETTI (Italian National and Trentino Regional HPH Network, Trento), Brian GAFFNEY (CEO, Health Promotion Agency Northern Ireland), Mila GARCIA-BARBERO (Head, WHO- European Office for Integrated Health Care Services, Barcelona), Johanna GEYER (Austrian Federal Ministry of Health and Women, Vienna), George GOLUKHOV (President, XXIst Century Hospital Foundation, Moscow), Oliver GRÖNE (WHO-European Office for Integrated Health Care Services, Barcelona), Tiiu HAERM (Estonian National Network of HPH, Tallinn), Maria HALLMAN KEISKOSKI (Finnish National HPH Network, Jyväskylä), Hubert K. HARTL (Austrian Federal Ministry of Health and Women, Vienna), Svend Juul JORGENSEN (WHO CC for Evidence Based Health Promotion in Hospitals, Copenhagen), László KAUTZKY (Hungarian National HPH Network, Budapest), Ann KERR (Scottish Regional HPH Network, Edinburgh), Karl KRAJIC (WHO CC for Health Promotion in Hospitals and Health Care, Vienna), Margareta KRISTENSON (Swedish National HPH Network, Linköping), Karl KUHN (European Network of Workplace Health Promotion), Mariella MARTINI (Emilia Romagna Regional HPH Network, Reggio Emilia), Raymond McCARTNEY (Northern Ireland Regional HPH Network, Londonderry), Irena MISEVICIENÉ (Lithuanian National HPH Network, Kaunas), Lillian MØLLER (Danish National HPH Network, Copenhagen), Paolo MORELLO MARCHESE (Tuscany Regional HPH Network, Florence); Denise MORRIS (English HPH Network, Lancashire), Peter NOWAK (Austrian National HPH Network, Vienna), Biddy O'NEILL (Health Promotion Advisor, Dept of Health & Children, Dublin), Ann O'RIORDAN (Coordinator, Irish HPH Network, Dublin), Jürgen M. PELIKAN (Chair Scientific Committee; WHO CC for Health Promotion in Hospitals and Health Care, Vienna), Barbara PORTER (Coordinator for HPH, Northern Ireland, Belfast), Fabrizio SIMONELLI (HPH Task Force on Health Promotion for Children and Adolescents in Hospitals, Florence), Viv SPELLER (London), Simone TASSO (Veneto Regional HPH Network, Castelfranco), Nina TIAINEN (President, Permanent Working Group of European Junior Doctors, Helsinki), Hanne TONNESEN (WHO CC for Evidence Based Health Promotion in Hospitals, Copenhagen), Yannis TOUNTAS (Greek National HPH Network, Athens), Nils UNDRITZ (Swiss National HPH Network, Suhr), Paul de RAEVE (Standing Committee of the Nurses of the European Union, Brussels), Gerard VINCENT (President, Standing Committee of the Hospitals of the European Union), Albert van der ZEIJDEN (President, International Alliance of Patients Organizations, Utrecht) Local Organising Committee Ann O'RIORDAN (Coordinator, Irish HPH Network), Barbara PORTER (Coordinator Health Promoting Hospitals, Northern Ireland), Luke CLANCY (Chairman, Irish HPH Network), Brian GAFFNEY (Health Promotion Agency Northern Ireland), Tom GOREY (Irish HPH Network), Hazel BROWN (Northern Ireland Regional HPH Network), Stephen WILSON (Health Promotion Agency Northern Ireland), Raymond McCARTNEY (HPH Coordinating Centre, Northern Ireland), Biddy O'NEILL (Department of Health & Children, ROI), Shay McGOVERN (Department of Health & Children, ROI), John BREEN (Department of Health, Social Services and Public Safety, Northern Ireland), Louis CARROLL (Fulcrum Medical Marketing, Dublin), Sarah PERRY (Fulcrum Medical Marketing, Dublin) 9

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11 Plenary Abstracts Plenary I: Thursday, May 19, 2005, The Hospital - A Staff Empowering Work Place OCCUPATIONAL SAFETY AND HEALTH ISSUES IN THE HEALTH CARE SECTOR AND STAFF EMPOWERMENT Sarah COPSEY The Agency was created by the European Union to provide the technical, scientific and economic information to people with an interest in safety and health at work. It has 3 key areas of activity: networking activities; information services; and carrying out projects resulting in reports on specific topics. The Agency carries out most of its information services via its website, and all its publications can be freely downloaded. The health care sector has been one of the Agency s featured sectors for information services because: there is concern about occupational safety and health in the sector, given the extent of the risks present; Member States themselves have highlighted the sector for future attention; and the risks in the sector are common across Europe European statistics and studies show the health care sector to be high risk, and demonstrate the extent of risks present. In the Agency study into the State of Occupational Safety and Health in the European Union, the health care sector was the forth most identified sector at risk by the Member States. The report identified high risks in the sector of: violence from the public; stress; bullying; work directed by social demands; reproductive hazards; biological hazards; heavy loads; occupational illnesses; and sickness absence. A report by the European Foundation for the Improvement of Living and Working conditions identified in addition: accidents; chemical substances; shift working; work organisation; and content and forms of work. These risks arise from physical working conditions, organisational restrictions and the social environment. Identified groups most at risk were all nursing staff and the various service and trade workers. Part of the Agency s work is to identify examples of good practice and analyse the results. The Agency has several cases from the health care sector, particularly in the area of stress and the prevention of violence from members of the public. An analysis of such cases clearly shows the importance of a no-blame approach, staff participation at all parts of the risk prevention cycle, and management commitment to their own-going involvement. In the case of psychosocial risks, the Agency has identified the following key success factors: adequate risk analysis; thorough planning and a stepwise approach; combination of measures covering anticipation, prevention, intervention, support and evaluation with main focus on collective prevention measures; contextspecific solutions; experienced practitioners and evidencebased solutions; social dialogue, partnership and workers involvement.; continuing staff feedback; liaison with external bodies police, judiciary, local community (in the case of violence); sustained prevention and top management support and resources. FURTHER INFORMATION Health care sector web feature: e/ Agency State of OSH report: dex.htm Agency, preventing psychosocial risks in practice: dex.htm Agency good practice publications (practical prevention/ prevention in practice series): htm Sarah COPSEY European Agency for Safety and Health at Work - OSHA Gran Via, Bilbao SPAIN + 34 (0) copsey@osha.eu.int MODELS OF GOOD PRACTICE FOR PROMOTING STAFF AUTONOMY: THE MAGNET RECOGNITION PROGRAM Karen B. HALLER The Magnet Award for Excellence in Nursing Service is the highest level of recognition that can be given to a health care organization which provides the services of professional registered nurses. The Magnet Award is the Olympic Gold for Nursing. The Magnet Recognition Program is administered by the American Nurses Credentialing Center (ANCC), a subsidiary of The American Nurses Association. Healthcare organizations around the world are using the program s concepts to assess and improve their nursing programs, because the principles are universally applicable. The Magnet designation has been awarded to large and small institutions, urban and rural facilities, and teaching and non-teaching centers. The Program requires healthcare organizations to document and demonstrate performance on 14 components, known as the Forces of Magnetism. These are: Quality of nursing leadership Organizational structure Management style Personnel policies and programs Professional models of care Quality of care Quality improvement Consultation and resources Autonomy Community and the hospital Nurses as teachers Image of nursing Interdisciplinary relationships Professional development Independent research on the effects of Magnet-related organizational characteristics demonstrates improved recruitment and retention of nurses, greater autonomy in nurses practice, better relationships with physicians, and even less needlesticks. Better patient outcomes have been identified in Magnet hospitals, including lower mortality rates; lower disease-specific mortality rates; fewer patient falls; and greater patient satisfaction. 11

12 In summary, Magnet institutions are characterized by giving high value and status to nursing, granting high levels of staff autonomy, yielding control over their practice to nurses, promoting accountability, and establishing a culture of professionalism. Karen B. HALLER Johns Hopkins University Hospital 600 North Wolfe St. Baltimore, Maryland Boston USA +1 (0) (0) khaller@jhmi.edu Plenary II: Thursday, May 19, 2005, Empowering hospital patients for managing their health EMPOWERING HOSPITAL PATIENTS AS PARTNERS IN THEIR DIAGNOSIS AND TREATMENT THE EXAMPLE OF BONE MARROW TRANSPLANTATION Hildegard T. GREINIX (AT) Although bone marrow and blood stem cell transplantation (SCT) is able to cure many patients with serious haematological and oncologic diseases, the procedure is still associated with significant morbidity and mortality. The high doses of chemotherapy, frequently combined with total body irradiation, cause extended hospitalisations and prolonged recovery periods. Informed consent discussions about the risks and benefits of SCT cover the procedure itself and the probability of disease-free survival. Issues of the long-term side-effects of intensive therapies, return to prior activities and reconstitution of normal levels of functioning are of tremendous importance for patients and their relatives in the decision-making process leading to admittance for or refusal of SCT. To ensure patient compliance with intense diagnostic and therapeutic procedures over lengthy periods of time, an extensive pretransplant work-up including multiple sessions of counselling by physicians, nurses and psychologists, visit of the SCT unit prior to admittance, talks with former patients and distribution of reading material has been established at our facility. In addition, psychosocial support of patients and their relatives during hospitalisation and outpatient care is provided by close cooperation of various health care professionals. To assess quality of life during SCT, prospective studies have been performed revealing elevated levels of anxiety and depression at some point before or during the two years after SCT. Therefore, psychological screening and interventions treating anxiety and depression are started before SCT and continue during the long-term follow-up of our patients. In prospective studies psychosocial factors like helplessness and hopelessness were associated with lower survival of SCT patients. Thus, psychological diagnostics before SCT to identify patients at risk and long-term psychological treatment of these patients are indicated. Our studies also revealed that realistic information from the staff about the often lengthy rehabilitation periods before resumption of prior activities is important. Knowing what to expect might help patients to reduce their frustration about shortcomings in the fulfilment of working and social roles until complete recovery. In summary, intensive counselling and education of patients and their relatives considering transplantation and reasonable expectations for recovery ensures high survival rates and improved quality of life of our patients and also is more satisfying for all health care professionals involved. Hildegard GREINIX General Hospital Vienna Währinger Gürtel A-1090 Vienna AUSTRIA +43 (0) (0) hildegard.greinix@meduniwien.ac.at EMPOWERING HOSPITAL PATIENTS FOR DEVELOPING HEALTHY LIFESTYLES WHAT CAN HOSPITALS CONTRIBUTE? THE EXAMPLE OF THE JYVÄSKYLÄ PEDE- PROJECT Leena LIIMATAINEN In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health (Health Promotion Glossary, WHO 1998). Both individual and community empowerment is needed while empowering hospital patients for developing healthy lifestyles. Individual empowerment emphasizes the patients abilities to make decisions concerning their lifestyles, and controlling their personal lives. Lifestyle counseling, including consultation on how to change one s health behavior, is a vital part of the management and prevention of many chronic diseases. According to the previous studies, nurses recognize that they are ill-prepared for lifestyle counseling, which aims to empower the patients for changing their health behaviors. To meet the challenge, the Patient Education Development Project (PEDE project ), was started in the internal medicine units of the Central Finland Health Care District. The project involved about 350 nurses and 23 internal medicine units. The aims of the project were: 1. the nursing staff will acquire new empowering patient education skills, 2. the _ounselling practices, material, networks and quality assurance methods are renewed in the working units. Developing a daily routine for lifestyle _ounselling means changes, which presuppose both individual and organizational learning. In the project, an experiential, transformative learning model was used to facilitate both individual and organizational learning, and the processes of change. The project realized the HPH program with a special emphasis on promoting the health of the patients and staff by creating a health-promoting and an empowering nursing culture. The implementing methods of the project were four different training programs and 19 patient education development projects managed in the working units by 56 change-agent nurses. The benefits of the project include a new empowering patient education competence and the changes in counseling practices in the working units, for example new lifestyle _ounselling material (tobacco withdrawal shelves, a health self-check corner), empowering group _ounselling models for rheumatoid arthritis and dialysis patients, virtual _ounselling folders, and the patient education quality criteria 12

13 for the nursing care plan. The successful development work has presupposed focusing on the particular challenges of everyday health promotion practices, working from down to top and in close collaboration with the hospital staff, the managers and the educational project experts from Jyväskylä Polytechnic. In the PEDE-project, a self evaluation form and a profile to explore the developmental needs of patient education practices were developed. Also an Empowering Speech Practices Scale (ESPS) for assessing the empowerment of dyadic _ounselling was piloted. The ESPS was constructed by PhD Tarja Kettunen on the basis of the empowerment theory and the foregoing conversation analytic research. According to the preliminary results, the ESPS describes the realization of empowerment directing attention to patient participation. In the presentation, the results of the PEDE-project and some suggestions for the future will be discussed. Leena LIIMATAINEN Head of Postgraduate Degree Programme Principal lecture in Helath Promotion Jyväskylä Polytechnic, School of Health and Social Care Keskussairaalantie 21E Jyväskylä FINLAND +358 (0) leena.liimatainen@jypoly.fi EMPOWERING HOSPITAL PATIENTS IN THE CONTEXT OF MAJOR HEALTH SERVICES REFORM IN Patrick DOORLEY The Health Service Executive (HSE) came into being on 1 st January While many countries have had reform of public services, never before has such an ambitious programme of reform been undertaken in the public service in Ireland. What this represents for the hospital community, patients, consumers, contractors, service providers, health service staff, patient support groups and the broader community, is an opportunity to build upon the strengths of our system and address the weaknesses which detract from a first class service. Health Promoting Hospitals strive to promote and improve the health and well being of key stakeholders. The concept of well-being is particularly important for hospital patients and their families. Quality of life and a sense of well-being may differ from patient to patient dependant on diagnosis, treatment, expectations and to what extent patients are empowered to participate in all aspects of their care. This is extremely important when we consider vulnerable groups in our community. The Health Service Executive can make a valuable contribution to models of good practice, which empower patients. Its basic structure supports a population health approach, which underpins service delivery. The establishment of the Health Intelligence and Quality Authority (HIQA), and the Regional Health Offices are but two of the new structures, which support a population health approach and strengthen consumer involvement in health services. Health Services internationally are facing enormous challenges. Public demands have never been higher. Empowering patients and the public can result in top quality services, developed in a spirit of partnership. This paper will explore how patients can be empowered to participate in health care services and particularly in their own care. Practical examples from the sharing of data to planning frameworks will illustrate how the developing Health Service Executive can contribute to empowerment. Patrick DOORLEY Health Service Executive National Director, Population Health Oak House Limetree Avenue Millenium Park Naas, Co. Kildare +353 (0) catherine.brogan@mailm.hse.ie Plenary III: Friday, May 20, 2005, Empowering vulnerable groups of patients EMPOWERING VULNERABLE GROUPS OF PATIENTS MENTAL HEALTH PROMOTION IN THE HOSPITAL SETTING Eva JANÉ-LLOPIS Mental and behavioural disorders are found in people of all ages, countries and societies. One in every four persons will develop a mental health problem during their life. In the year 2002, neuropsychiatric conditions accounted for more than 20% of all European disability adjusted life years. Mental illhealth is also common in people with physical illness; for example 22% of people with myocardial infarction and 33% of people with cancer suffer from major depression. Social and economic costs of mental health problems (estimated at 3-4% of GDP) are wide ranging and long lasting, including health and social service costs, lost employment and reduced productivity, the impact on families and caregivers, and premature mortality. Evidence demonstrates that, when properly implemented, mental health promotion and mental disorder prevention interventions lead to a range of positive health, social and economic outcomes. Effective approaches across the life span by health care professionals or involving primary and secondary health care settings in implementation include home-based interventions for infants and families, targeted preventive interventions for groups at risk (e.g., carers, people with chronic illness), prevention of work related stress and depression and mental health promotion for elder populations. Such interventions have lead to improvement in positive mental health and quality of life and reductions in aggression, stress, symptoms of anxiety, depression and suicide, with the associated social and economic benefits that these mental health outcomes bring. 13

14 Different training opportunities and implementation initiatives can be integrated in health promoting hospitals to support the mental health of its patients and workers. This paper will present the problem of poor mental health in secondary health care, outline some effective interventions to promote mental health and prevent mental disorders and will explore opportunities to integrate mental health promotion components into health promoting hospitals. Eva Jané-Llopis Head, Science Based Knowledge and Policy University of Nijmegen Department of Clinical Psychology P.O. Box HE Nijmegen THE NETHERLANDS +31 (0) CULTURALLY COMPETENT AND MIGRANT FRIENDLY HOSPITALS: THE SOUTHERNMOST ENTRANCE TO THE EUROPEAN HEALTH SYSTEMS AN EXAMPLE FOR EMPOWERING MIGRANT PATIENTS Antonio SALCEDA DE ALBA Hospital Punta de Europa HPE - is a small-town community general hospital with a total of 350 beds. Located in the health authority district of Campo de Gibraltar, at Algeciras in the far south of Spain, near the Strait of Gibraltar, it is only 18 km from the African shore. Clearly enough, the demography of the population we attend to in our hospital is strongly influenced by our geographical situation. Besides, our health coverage area is changing in character from being a transit area to being a settlement area. HPE is integrated in a publicly owned health service, the Andalusian Public Health System (SSPA), which has a policy of full equality in access to our public service, ensuring free health care to all people, also in cases of undocumented migrants. Through other public organisations like Fundacion Progreso y Salud and different agreements with trade unions and NGO s, Andalusia is already making a special effort to integrate migrant communities and improve their health status. During two years and a half, we have implemented at HPE - in collaboration with other eleven European hospitals, and coordinated by the LBISHM - the EU project Migrant Friendly Hospitals, aimed at improving accessibility to health resources for migrant populations and ethnic minorities. We will describe why our hospital got involved in this project, what we aim to by being the southernmost entrance to the European Health systems, and will share some of the lessons learnt in the journey. Enjoy the experience! Antonio SALCEDA DE ALBA Hospital "Punta de Europa" Servicio Andaluz de Salud Ctra. De Getares, S/N Algeciras SPAIN +34 (0) antonio.salceda.sspa@juntadeandalucia.es HOW CAN THE HOSPITAL BECOME A GOOD PLACE FOR OLDER PATIENTS? Virpi HONKALA The care for ageing patients sets increasing demands on hospital health promotion due to several reasons, not the least important being the relative growth in the number of senior inhabitants in the population. As it is true that the senior citizens of this day may be older but fitter, it is as true that there are causes, which appear to ruin good ageing. Musculosceletal disorders, including osteoporosis and e.g. fractures lead easily to diminished mobilization. Diabetes with its cardiovascular, cerebral and neurological complications forms a growing threat of severe disablement. Dementia eventually leaves no alternative but the one suffering from it to be permanently hospitalised. Impairment of hearing and vision causes difficulties in coping with everyday tasks. Loneliness worsens the quality of life. How to know what we have ahead and how to respond to it? In Raahe area with about inhabitants, 14.6 % of the population is over 65 years and 1.4 % over 85 years of age. In 2004 all citizens born in 1939 were invited to attend a study conducted by a registered nurse. 88 % of 357 participated. Only those who already had frequent visits due to chronic diseases or a few who had no previous visits to public health care or suffered from alcoholism showed no interest in taking part. Basic laboratory examinations including blood cell counts, creatinine, TSH, B12 and folate, calcium, fb-glucose, cholesterol and triglycerides were analysed. The nurse carried in her tool kit a laptop, scale and measuring tape, blood pressure apparatus, charts for vision examination, PEF-meter and tests of memory and mood. The participants length, weight, hearing and sight were measured. Questions concerning general health, medication, chronic illnesses, physical conditions, sleeping habits, social life including friends and hobbies, living conditions, memory and mood, past working history, security and plans for the future were asked. Blood pressure and PEF were measured. The results of the study showed that the overall physical condition of the participants was fairly good. 95 % had plenty of friends and hobbies and they were happy with life. Most of them had a long continuous history of work and they appeared to be strong individuals despite of hardships in life. They were also quite enthusiastic about changes in life. However, the study revealed many troubles to be expected in the future. 48 % had medication for hypertension. Despite of that 39 % had blood pressure above 130/ % were overweight with BMI more than 30 and 9 % undernourished with BMI less than % had fb-glucose level above 5.5 mmol/l and 66 % cholesterol level above 5 mmol/l. Only 39 % had normal bone density. 14 % were smokers, 6 % were former heavy drinkers and 13 % had minimal memory problems. When an elderly person is hospitalised, many things must be taken into consideration. The symptoms may appear faint or small, there are several illnesses, additional diseases, wrong use or type of medication, poorly understood directions or no cure for the disease. The patient may not be able to describe the illness. A quick deterioration may follow due to delay in treatment. The general condition of the patient may be poor because of unsuitable living surroundings. The hospital staff faces special demands with a senior patient. Often the condition or situation of the elderly is not known. The resources are limited, everyone is in a hurry, there is no geriatric knowledge and even the attitude may be pessimistic. When the illness is serious, there may also be 14

15 overly high expectations or unrealistic goals. Four main points are valuable in dealing with aged patients. Mobilization is of utter importance. A week in bed diminishes one quarter of muscular power. Problems of skin, blood circulation, digestion, drug metabolism, mental condition just to mention a few are encountered if the patient is not activated. Nutrition with proper vitamins should be balanced. Since the patients may have difficulties with eating, they should be properly assisted. The relatives or people in close contact with the patient are extremely important to be included into the care process. And finally, a caring and considerate attitude as it is expected with every patient should be emphasized when dealing with an often fragile and sometimes very disoriented senior citizen. Virpi HONKALA Raahe District Hospital PL Raahe FINLAND +358 (0) virpi.honkala@ras.fi Plenary IV: Friday, May 20, 2005, Frameworks for empowering hospitals to become empowering organisations SUPPORTIVE LEGAL, FINANCIAL, AND QUALITY FRAMEWORKS FOR HPH Oliver GROENE More than a decade ago the WHO Health Promoting Hospital project was initiated in order to support hospitals towards placing more emphasis on health promotion and disease prevention, rather than on diagnosis and curative services alone. The network has expanded considerably over the years, however, hospitals and networks in some countries have faced substantial difficulties in supporting the agenda of health promotion in hospitals and convincing new hospitals to join. The presentation will address some of the legal, financial and quality frameworks that can facilitate or obstruct the expansion of health promotion activities in hospitals. A review of legal requirements in health care will yield very restrictive approaches to quality, such as blood safety, nuclear medicine, professional regulation and laboratory standards. Legal requirements may further address certification and possibly, in the most advanced cases, address accreditation of health care institutions or newly established regulations regarding patient safety. Accreditation standards, however, typically make little reference to health promotion activities. And while it is of utmost importance to improve patient safety, most approaches are characterized by their control function and a stronger focus on improvement and health gain is required. A major obstacle to expanding health promotion in hospitals is the lack of incentives. Professionals in hospitals work under a lot of pressure and there is little time and space for health promotion. A number of projects and programmes have identified this issue and demonstrate that, specific investments provided, health promotion is a worthwhile investment for hospitals and for the health system. A task force within the HPH network has started a project to link health promotion to reimbursement in order to institutionalize health promotion in hospitals. Hospitals are exposed to a great variety of quality models most of which focus on the clinical effectiveness of services and hence neglect the focus on groups of stakeholders (e.g. staff) and the benefit of health promotion. What explains this focus? Specific quality standards and indicators for health promotion in hospitals were developed and pilotimplemented in hospitals and show that health promotion can be assessed and the actions for improvement can be identified. Clinical effectiveness is at the core of the production process in hospitals, but it has become very clear over the last decade that health promotion, too, is an important issue for patients, staff and community issues. In order to institutionalize health promotion and reorient hospital services a mix of legal and financial incentives plus implementation tools are required. The presentation will draw on these resources and pinpoint to new and promising developments in this field. Oliver GROENE WHO-Regional Office for Integrated Health Care Services Barcelona Marc Aureli Barcelona SPAIN +34 (0) OGR@ES.EURO.WHO.INT ENABLING HOSPITALS TO BECOME EMPOWERING ORGANISATIONS Jürgen M. PELIKAN HPH is not just a vision, but since 15 years around hospitals have been involved and trying to implement the concept, more ore less successfully. But, even hospitals is just a small fraction of the estimated hospitals in WHO-Europe. Looking at the hospitals who have already tried HPH, in most cases only a limited range of the concept has been implemented so far. Why is HPH not yet implemented in a wider and more comprehensive scale? As any reform strategy for hospitals, HPH can only be implemented as far as is allowed and supported not only by the internal structure and culture of the hospital, but by the relevant environments as well. Business plans and everyday practice in hospitals are especially influenced by national and regional legal (organisational, quality regulations, division of labour between hospital and other providers of the health care sector) and financial frameworks and incentives. Considering the 18 strategies of the WHO working group Putting HPH policy into action, supportive or hindering conditions will differ at least for implementing the 9 quality strategies or for the 9 strategies for strategic positioning of services offered. Therefore it makes sense to have a closer look at conditions which have been supportive and hindering for implementation of HPH in Europe so far. What can the international network and the national and regional networks together do 15